Outcomes and Costs After Robotic vs Laparoscopic Complex Elective Cholecystectomy

Area of Science:

• Minimally Invasive Surgery
• Surgical Technology
• Gastrointestinal Surgery

Background:

• Robotic cholecystectomy use is rising, but its value in complex elective cholecystectomy (CEC) is unclear.
• CEC involves complex gallbladder pathology, increasing surgical difficulty.
• Defining the comparative effectiveness and cost of robotic vs. laparoscopic approaches in CEC is crucial.

Purpose of the Study:

• To compare clinical outcomes and total hospital costs between robotic and laparoscopic approaches for CEC.
• To evaluate the impact of surgical approach on postoperative interventions and complications in complex gallbladder surgery.

Main Methods:

• A cohort study analyzed data from an academic hepatobiliary referral center (August 2018 - August 2024).
• Patients undergoing cholecystectomy were categorized into CEC and non-CEC groups.
• Primary outcome: composite of unplanned postoperative interventions; Secondary outcomes: operative time, complications, costs.

Main Results:

• Robotic approach for CEC was associated with significantly lower rates of unplanned endoscopic or percutaneous interventions (OR, 4.24; P=.02).
• No significant differences in postoperative outcomes were observed between robotic and laparoscopic approaches for non-CEC.
• Laparoscopic approach had lower operating room costs, but overall total costs of care were similar for robotic and laparoscopic CEC.

Conclusions:

• Robotic cholecystectomy provides a clinical advantage in complex gallbladder disease, reducing complications and downstream interventions.
• The strategic use of robotic platforms in high-complexity gallbladder surgery can maximize patient benefit and resource efficiency.
• Robotic surgery for CEC does not increase overall costs of care despite higher operative room expenses.